title: Left ventricular assist device malposition interrogated by 4-D cine computed tomography.
abstract: 67-year-old female with left ventricular assist device (LVAD) presented with recurrent low-flow alarms. No clear etiology could be determined by history, or evaluation with radiograph and echocardiogram. Computed tomographic (CT) imaging with 3-D and 4-D assessment identified the abnormality as steep angulation of the inflow cannula and partial obstruction by the adjacent anterior wall, likely in part caused by recovered left ventricular function and reverse remodeling. Improved left ventricle size and function was correlated by semi-automated analysis of CT data, which also indicated mild right ventricle dilation and systolic dysfunction. LVAD explantation was performed, and has been well tolerated by the patient. Echocardiography remains the primary imaging modality to assess patients post LVAD placement, but in this instance CT provided valuable information to identify the abnormality and help direct patient management. CT assessment in patients with LVAD additionally provides valuable information prior to redo sternotomy for pump explantation, revision, or transplantation.
authors.affiliation: Imaging Institute Cardiovascular Imaging, Cleveland Clinic, 9500 Euclid Avenue/J1-4, Cleveland, OH 44195, USA. bolenm@ccf.org
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bolen
authors.forename: Zoran B
authors.initials: ZB
authors.lastname: Popovic
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gonzalez-Stawinski
authors.forename: Paul
authors.initials: P
authors.lastname: Schoenhagen
mesh_terms: D000368:Aged; D056902:Clinical Alarms; D020878:Device Removal; D018618:Echocardiography, Doppler, Color; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D020127:Recovery of Function; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling